Elevated ADHD symptoms linked to depression and anxiety in women with epilepsy

Abstract Background Attention-deficit/hyperactivity disorder (ADHD) is commonly comorbid among women with epilepsy, with the typical male predominance in ADHD not seen in people with epilepsy. ADHD symptoms often persist into adulthood; however, data on their nature remain limited in women with epilepsy. We examined the frequency of self-reported ADHD symptoms in a sample of adult women with epilepsy and their relationships with disease parameters, depression, and anxiety. Methods Women with epilepsy from The Raoul Wallenberg Australian Pregnancy Register of Antiepileptic Drugs completed the Adult ADHD Self-Report Scale (ASRS-5), Neurological Disorders Depression Inventory for Epilepsy, and brief Epilepsy Anxiety Survey Instrument. Linear regression examined associations between ADHD symptoms, age at seizure onset, epilepsy type, depression, and anxiety. Network analysis visualised partial correlations among individual ADHD, depression, and anxiety symptoms. Results Among 109 women with epilepsy (mean age 44.9 ± 5.1 years), 47 (43%) screened positive for ADHD on the ASRS-5. Of these, 60% also screened positive for depression and 36% for anxiety. ASRS-5 scores increased with younger seizure onset age (R² = 0.04, p = 0.046), depression (R² = 0.34, p < 0.001), and anxiety (R² = 0.32, p < 0.001). Network analysis showed frequent connections between ADHD, depression, and anxiety; the strongest cross-domain association linked the ADHD symptom difficulty unwinding with the anxiety symptom difficulty relaxing (r = 0.41). Conclusions Women with epilepsy report elevated ADHD-related symptoms that are closely associated with psychological distress. The unexpectedly high yield of positive screening outcomes on a generic ADHD screening measure suggests tailored assessment approaches may be required to differentiate ADHD from common psychiatric comorbidities of epilepsy and guide treatment selection.